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Thursday,
September 09, 2004 - San Anselmo firebrand Sarah Nome, often at odds
with City Hall, now is taking on Kaiser Permanente from her hospital
bed.

Kaiser
officials say Nome shouldn't be in their hospital at all, but Nome
disagrees and has refused to leave the Kaiser Permanente Medical Center
in Terra Linda - even though she was officially discharged from the
acute care unit on Jan. 29.

In
the meantime, bills have mounted at a rate of $3,200 a day and now
total well over $300,000.

Kaiser
officials want her out and have filed a lawsuit seeking her eviction.
But Nome, a feisty Marin civic watchdog who tossed barbs at local
officials for decades, says she has no plans to leave.

In
addition, Kaiser has filed a lawsuit saying Nome fraudulently
transferred her home to her daughter, Jane Sheldon Sands of Brisbane,
in February, and is asking the court to set the deed aside until the
case is resolved. The house, at 77 Alder Court in San Anselmo, is
valued at more than $400,000, according to the lawsuit.

Nome
says she cannot leave the hospital because she has two broken knees and
cannot walk. She also believes she is the victim of elder abuse at the
hands of a care facility in Greenbrae, Kaiser and others.

Known
for her strong opinions on a variety of topics, Nome isn't likely to
budge from her room at Kaiser. She even keeps a June 17 bill for her
lodging through May 31 on her bed to show visitors. It was $302,129
then, and it's climbing.

Kaiser
officials say the lawsuits were filed as a last resort because neither
Nome nor her daughter were willing to cooperate.

Nome
isn't able to appear in court and has been represented by Sands, who
was granted the family home from her mother shortly after her discharge
was ordered by Kaiser. Sands had tried to get assistance from Legal Aid
of Marin but did not qualify for services, so she has worked the case
herself and plans to hire a lawyer to win her mother a jury trial.

Sands
said Nome will remain in Kaiser indefinitely.

"Right
at this time, that is true," she said.

Last
week, another Marin fixture, attorney Carl Shapiro, agreed to represent
Nome at no cost in her battle with Kaiser.

According
to the Kaiser suit, Nome was admitted to the hospital on Jan. 22 and,
when physicians sought to arrange her discharge seven days later, she
refused to go.

The
next day, Nome was no longer covered by her Kaiser insurance for the
hospitalization because she had been released, and she was told she
would be billed for services provided.

Kaiser's
lawsuit complains that officials believe Nome's home "was received by
Sands with knowledge that Nome intended to hinder, delay, or defraud
the collection of the plaintiff's aforementioned claim, and the claims
of other creditors."

The
suit also contends that Sands has been intimately involved in Nome's
financial affairs for many years and alleges a conspiracy because Sands
knew Kaiser's claim could only be satisfied with the sale of her
mother's home.

In
a written response to the lawsuit, Nome acknowledged that Kaiser is
legally entitled to remove her from the premises at any time but stated
that such removal would "work undue hardship, irreparable harm, or
immediate danger" to her.

"The
plaintiff would experience little to no harm, injury or damage with
such a stay," Nome further stated.

Stanley
Watson, senior legal counsel for Kaiser Foundation Hospitals, said
Kaiser is not trying to get Nome's home but, instead, is looking out
for her welfare.

"This
case has never been about the money, this case has been about engaging
her in trying to get an appropriate placement," Watson said. "It's a
way to demonstrate the inappropriateness of her occupying a hospital
bed. We also were somewhat concerned she had transferred her home to
her daughter's name."

There
is no lien on the home, Watson said.

"There
is just a notice that the house is the subject of a lawsuit so it
remains available to her," Watson said.

Officials
at Kaiser could not comment on Nome's medical situation specifically
other than saying her condition is "good," but added patients are
discharged only when they are evaluated by a physician and criteria are
met.

"The
most appropriate place (for discharge) is determined and whenever
possible we work with the patients and their families to find the most
appropriate setting," said Carol Harris, a Kaiser spokeswoman. "I can
assure you we work very effectively."

Harris
said that hypothetically speaking, a patient who does not leave the
hospital after being discharged is no longer covered by the Kaiser plan
because there is no medical need. A patient may follow a process for
appeal, however.

If
the patient chooses what is called "custodial care," he or she is
provided room, board and assistance for daily living at a daily rate.
Custodial care is not covered by Medicare, universal health guidelines
or Kaiser, Harris said.

If
a patient cannot pay for medical costs, Kaiser makes efforts to provide
financial counselors to work with families and develop payment plans.

"Kaiser
is always ready and willing to amicably resolve any issues and we are
always looking for ways to come to an understanding," Harris said.

Nome
believes she should be covered by Kaiser for her lengthy stay because
under an agreement with her former employer, the National Maritime
Museum in San Francisco, she has been kept on payroll because she did
not have a pension plan. Her monthly check includes deductions for the
Kaiser plan.

Nome,
who on Jan. 20 filed a medical malpractice lawsuit against Greenbrae
Care Center and named the Kaiser Foundation Health Plan, the Permanente
Medical Group and Kaiser Foundation Hospital as parties, believes she
is a victim of elder abuse.

She
claims she was neglected and abused, and that the facility failed to
diagnose her with osteoporosis.

She
further complained that caregivers failed to properly manage her
medications and injected her with medications against her will.

Kaiser
has contracts with Greenbrae Care Center and Hillside Care Center in
San Rafael, where Nome also stayed, but is not otherwise affiliated
with the centers, according to Harris.

Sands
had filed a report with the Twin Cities Police Department Jan. 26,
2003, but an investigation deemed the complaint unfounded, according to
Sgt. Steve Fogel.

Fogel
said the report claimed that Nome was injected with a drug that
investigators found only comes in pill form. The investigation also
determined that Nome was treated for cardiac arrest by fire department
personnel and not by Greenbrae Care Center staff.

Robert
Peirce, chief executive officer of the Greenbrae facility, would not
comment on the litigtation.

Nome's
lawsuit is pending but her former lawyer, Douglas Fladseth of Santa
Rosa, has been relieved from the case by the court at his request.

Fladseth
said he declined to continue his representation because medical
malpractice lawsuits are involved and expensive.

Nome
sees her situation as a warning for other seniors and says they need to
be alerted about what can happen when patients are dismissed as
feeble-minded.

"I
recommend to anybody that is older to think about it ahead of time,"
Nome said. "They can claim you are not capable."

She
also believes her only asset is appealing to her creditors.

"They
wait until you are feeble and old and all they want is your real estate
- Marin County real estate," Nome said.

Kaiser
officials say they just want to make an arrangement to get Nome to an
appropriate setting and would consider forgiving part of her debt.

"A
global resolution is what we are looking for and forgiving a piece of
the debt could be a piece of that," Watson said.